Qn “Is there an effective therapy that can help support patients with long-drawn illnesses? I recently walked into a hospital ward with patients who have ailed for a long time and most of them looked heavily depressed”
The faculty of liaison psychiatry was established in 1997. This was in recognition of the fact that 30-40 per cent of patients in general medical wards were also suffering from mental disorders.
The fact that a person is in a medical bed and was diagnosed with diabetes or cancer did not protect him from an additional diagnosis of depression. A recent study from Birmingham (UK) showed the financial benefits of involving psychiatrists in the treatment of persons with medical conditions.
It had been established many years earlier that up to 30 per cent of patients who attend primary health care facilities go there mainly for the treatment of common psychiatric disorders. About 15 years ago, Drs. Marx Okonji, Pius Kigamwa and myself studied this question in Maseno District. We later published the results.
In essence, we established what was known form earlier studies. We found for example, that 11 per cent of the people who were living in the community lived with diagnosable common mental disorders.
Like others before us, we found that up to 30 per cent of the people who went to the local health centre suffered from common mental disorders, the majority of which were not recognised as mental disorders, and were therefore not given proper treatment.
Such conditions were treated as malaria, myalgia, back pain, headache but no relief came to the depressed patients.
We also found that these patients kept coming back to the clinics causing much congestion. They also received many investigations, which as in the case of Birmingham were very expensive.
In a later intervention, we were able to demonstrate that a five-day course of training of clinical officers gave them adequate skills not only to diagnose but also to treat common and often missed, common psychiatric disorders. This rather lengthy story is intended to show you that it is not for lack of knowledge that patients such as you saw suffer, it is for lack of the implementation of what we know.
A few examples will make this point.
When a person suffers from diabetes, chances that he will also suffer from depression are doubled! We also know that persons with depression are less likely to be motivated to follow instructions given by the expert in diabetes.
As the expert in diabetes wonders why the patient is not getting better in spite of being given the correct dosage, the patient gets deeper into depression. It is perhaps this type of patient that you saw! Doctors must learn how to treat BOTH the diabetes and depression!
Perhaps you were in a cancer ward. If that is where you were, then at least half of the patients were suffering from both cancer and depression. In addition to the fact that a diagnosis of cancer is depressing to many people, the fact that patients do not get full or formal evaluation of depression makes for the scenes that you saw.
The fact that one has cancer makes it more likely that they will get depression, which is a treatable medical condition.
There is the possibility that you went into an Infectious Diseases Unit where patients with Aids were being treated for TB again, chances are that some had undiagnosed and untreated depression. That is what you might have seen.
It also possible that you went to a ward where patients were being treated for heart diseases such as heart attacks. Just in case you would like to know, heart disease and depression are common companions. Heart disease can lead to depression.
Perhaps you went to a unit where experts treated heart disease and forgot to treat the depression the patient also suffers from. As you must have gathered by now, many people with kidney disease undergoing dialysis are also depressed.
Very sadly for all of us, your observation is absolutely right. Some doctors are not as observant as you!